Parenting: Dealing with Encopresis

For those new readers who haven’t been reading my blog for years, I am a self-taught expert on dealing with pediatric constipation and stool withholding. After weaning my now five-year-old daughter at age two, constipation has been a challenge in our family. We’ve consulted a number of physicians and GI specialists. We cut lactose completely from her diet. We tried any number of solutions, none of which worked for more than a few weeks. We learned that some children just suffer from functional constipation — which is, constipation that doesn’t have a medical cause.

It barely needs mentioning here that if your infant or young child suffers from constipation, a number of conditions need to be ruled out medically by a GI specialist. Getting a diagnosis of functional constipation is important as a first step to moving toward a methodology for treating it that works for you and your child.

Friends with good intentions have suggested a number of solutions over the years. I’ve, of course, tried them all, before they even suggested them. Still, I would listen patiently to the advice to add prunes and prune juice, to try mineral water, etc. Others tried to suggest that it’s a behavioral issue. She’s a stubborn child. She’s lazy. She’s misbehaving. She wants to still be “the baby.” The one that hurt the most was when they blamed me for not giving her enough attention.

My little girl suffers from encopresis, a fancy word for stool withholding. Encopresis occurs as a result of constipation. It’s the psychological conclusion to a biological problem. As a matter of fact, according to this article on KidsHealth.org, MOST cases of stool withholding (about 90%) are due to constipation.

Why does a child withhold stool? Fear of pain. It’s that easy. Eventually, as your child gets older, more complex issues arise, such as depression, lack of self confidence, fear of repercussions. It’s a vicious cycle. A child withholds stool out of a fear that trying to pass it will hurt. So the cycle continues and worsens. Adults who don’t understand the condition actually make it worse by punishing, threatening, and belittling. Any caregiver of your child needs to know the facts. That means informing grandparents, daycare workers, babysitters, and other adults in your child’s everyday life so that they know what their responsibility is toward helping the child overcome the condition.

What’s it like to live with this challenge? Here’s a snapshot:

About six weeks ago, Laurel sneakily ate two bananas, in a row. Bananas are very binding, so we usually don’t even keep them around. But I was having a craving, so I had a bunch sitting around for me to snack on.

Anyway, we were, prior to this, DONE with the encopresis, finished with accidents, totally over the constipation. For months. After the bananas, there was, apparently, a painful attempt on the toilet. And voila, we are back at step one in the cycle of encopresis.

We know the routine. Increase the Miralax, up her hydration, cut the juices with water, moderate dairy, increase the ruffage, add more raw veggies, make sure she gets more exercise, and hope it works itself out in a few days. Sometimes we give a small dose of ex-lax to stimulate her colon. One of the side effects of encopresis can be decreased muscular reflex in the colon. She may not feel the urge to poop. A stimulant can help, as long as it’s given with the advice of a doctor and in moderation. In most cases, we experience one or two steps back at this stage, and then fast forward to where we were before the binding event. Done.

Not this time. And I think compounding the problem (so to speak…) was another significantly upsetting change in her world: A newly pregnant and very distracted mom who was all of a sudden having trouble staying awake, never mind keeping track of her child’s eating and defecating cycles. Because having a child with this challenge takes vigilance. I have to be aware of what she’s eating, and tracking when she’s going. At some point, she will outgrow this condition. Until then, it’s my responsibility to help her succeed and remain positive and motivated.

Four weeks pass without any stool. Followed by a week of leakage in her panties as some of the softer stool makes its way past the obstruction in her colon. We’re now in that stage where talking about dietary changes is a waste of time. The psychological component is all that matters. I clear my calendar for the week, take a few days off from playdates, outings, appointments, socializing. It’s important to help her preserve her self esteem and work on her confidence so that she can succeed in battling the fear. I offer positive reinforcement and lots of affection. We read a lot of stories on the toilet, take warm baths, and go for walks.

It’s hard work for the parent/caregiver. I’m not perfect. I get impatient. I lean on my awesome husband and good friends to help keep my spirits up. Cleaning panties all day long, bleaching out the sink a few times a day — these things wear a parent down. Having a good support system in place, especially if you are home with your child all day long, is essential. You are your child’s cheerleader. And when you get worn down, impatience, frustration, disappointment and even parental depression are the results. Of all the literature I’ve read thus far on this condition, I’ve never read an article that talks about the parents’ emotional needs. So I’m mentioning it here, and it may warrant a separate article. Get some support. Make sure your needs are met, that you get breaks and time away to refuel.

Anyway, eventually, my little girl gets to the point where she wants to negotiate with me for positive reinforcement. She’ll do an art project — a poop chart, and she’ll come up with some ideas for rewards. She’ll start getting into the idea that there is at least ONE positive aspect to her succeeding on the toilet. Sometimes it’s a trip to the museum, or a toy she’s been wanting. We talk about what she needs to do to accomplish her goal. And then, with the external motivation in place, she’ll make an effort. After a few attempts, she’ll succeed, and she’ll realize the OTHER motivation to making the effort. Relief. And then we’re on the road to returning to normalcy. I follow through on the external motivation. But the more important one is the internal one. I now have a child who is proud of herself, again, for making the effort to take care of her body’s needs.

If your child suffers from encropresis, too, there are some excellent resources for you. Honestly, just plug in “encropresis” on a google search. Pick the top 10, and you’ll read something useful. You can even read about other mommy bloggers who have children who suffer from constipation. One of these is the awesome and completely hilarious Heather Armstrong at Dooce.

Childhood constipation is a relatively common condition. The myth is that adding prunes or prune juice to your child’s diet will work magic. But it’s a lot more complicated than this. First of all, you can’t force feed a child, or you have even more complex problems down the road. Prunes and prune juice do not work if you can’t get your child to consume them. And when constipation leads to stool withholding, it’s not the food that is the root of the problem. It’s the fear. There will always be times when Laurel eats something binding, doesn’t drink enough water, etc. You have to have a system in place for taking care of the biological component, and giving your child the psychological tools she needs to help her succeed.

4 Responses to Parenting: Dealing with Encopresis

I am impressed (but not surprised) by your thoughtful, loving, and honest description of this difficulty. If there is anything I can do to relieve you or assist (like bringing veggie sushi again!) please let me know. I love that dear sweet girl.

My two year old has had diahrea pretty much since he was born. Have been seeing a peaditrician for almost a year… who told me it was toddlers diahrea and he will outgrow it by the time he is five. It continued so I asked my family dr. to send him to a GI. Saw her last week. She said he had encopresis. He is on two liquid laxatives a day for a month and on top of that to give him 5 squares of exlax both Sat and Sun of this weekend and on Sat. only for the next 4 weekends. Then come back to see her. I feel this is excessive, but am follwoing drs. advise. My two year old is pooping out only water since taking these laxatives. Do you think this is normal? PS. He is not toilet trained.

THANK YOU for this article. My son has been suffering from encopresis for about 6 months now, and today was just awful. We went through 4 pairs of underwear – and my ability to cope was just shot. The afternoon ended with us both in tears and me making him sit on the potty “and not get up until you poop.” Not a proud parenting moment.